facilities-only option - an option that covers services provided in a nursing home or assisted living facility, hospice care in a facility, and respite services in a facility, bed reservations and caregiver training.
family member - for determining whether benefits are payable for formal or informal care under your policy. This term means your spouse, child (natural, step or adopted), parent, sibling, in-laws, or grandchild.
formal care - care which is provided by a home health aide or homemaker arranged or supervised by a home care agency, or provided by a nurse or therapist.
free look period - a protection included in policies which allows you to cancel coverage within 30 days after you receive your benefit booklet and receive a complete refund of any premium you paid.
full underwriting - the type of underwriting that you would undergo if you applied for an individual policy in the private market. Full underwriting means that applicants will have to answer numerous health-related questions. It may also include a review of medical records and/or an interview with a nurse.
future purchase option - an inflation protection feature that allows you to periodically purchase additional coverage without proof of good health.
grace period - the time which a policy will allow after the due date before cancellation.
guaranteed renewable - a feature of tax-qualified long term care insurance plans, whereby an insurance company cannot cancel or fail to renew coverage because of a change in a person's health or age. As long as premiums are paid and benefits have not been exhausted, coverage will continue. When a plan is guaranteed renewable, premiums may be changed on a group basis only.
hands-on assistance - when you require physical help by another person without whom you would not be able to perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for hands-on assistance only.
Health Insurance Portability and Accountability Act (HIPAA) - Federal health insurance legislation passed in 1996 that specifies conditions under which certain long term care insurance policies qualify for tax advantages.
home care - services provided at home which may include nursing care; occupational, physical, respiratory or speech therapy; personal care; and homemaker services. Comprehensive plans cover home care services.
home health aides - individuals who provide care to older adults or people with disabilities at home. Training or certification may vary for home health aides, but typical services they provide include assistance with activities of daily living, managing medications, and some household tasks. Comprehensive plans cover services from home health aides.
homemaker services - household chores performed for someone unable to do them on their own. Comprehensive plans cover homemaker services.
hospice care - services provided by a hospice for the care or management of a terminal illness.
inflation protection - a feature or option of long term care insurance coverage that increases the value of benefits over time to keep pace with increasing costs of care. Policies offer a choice of two inflation protection options - an automatic compound inflation option and a future purchase option.
informal care - care provided by an unlicensed caregiver whose services are not arranged and supervised by a home care agency. Comprehensive plans include coverage for informal care.
lapse - termination of insurance coverage when premium is not paid.
Licensed health care practitioner - a physician, any registered professional nurse, or a licensed social worker.
lifetime benefits - see unlimited benefit period
long term care (LTC) - personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. It can be provided at home, in a nursing home, assisted living facility, or an adult day care center.
long term care insurance - insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment and allows you to receive the type of care you need in the setting that's right for you.
maximum lifetime benefit - this is the maximum amount of benefits that your insurance coverage could pay. The maximum lifetime benefit can also be referred to as a "pool of money". Your maximum lifetime benefit is calculated by multiplying your daily benefit amount times the number of days in the benefit period you selected.
Medicaid (Medi-Cal in California) - the joint Federal-state program that pays for health care services for individuals who meet their state's poverty guidelines.
Medicare - a Federal health care program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.
Medicare Supplement Insurance (Medigap) - private insurance to help pay hospital and medical costs Medicare does not cover. It pays for long term care under limited circumstances and for limited periods of time.
non forfeiture - a feature that provides some value in the event coverage is cancelled. Contingent non forfeiture is one type of nonforfeiture benefit.
Nursing care - services requiring the professional skills of a nurse (R.N.), licensed practical nurse (L.P.N.) or licensed vocational nurse (L.V.N.).
nursing home - a licensed facility that provides 24-hour-a-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services. Both Facilities-Only and Comprehensive plans include coverage for care received in nursing homes.
OPM - the U.S. Office of Personnel Management.
original effective date - the date that coverage under a policy becomes effective.
personal care - care to help you meet personal needs such as bathing, dressing and eating.
plan of care - a plan prescribed by a licensed health care practitioner that identifies ways of meeting your need for long term care services. To receive benefits under a policy, you must have a written plan of care that the company
pool of money - see maximum lifetime benefit.
premium - the money paid to an insurance company for coverage. Policies have several methods to pay premiums - automatic bank withdrawal or direct billing.
respite services - services by a substitute provider, from a few hours to a few days, to give time off to the regular caregiver. A benefit of some long term care insurance plans.
schedule of benefits - the customized listing of your benefits. You will receive a copy of your schedule of benefits if you apply for coverage and you get approved. This schedule, together with your Benefit Booklet, describes your coverage.
severe cognitive impairment - the deterioration or loss of intellectual capacity that requires substantial supervision by another person.
spend down - depletion of income and assets to meet eligibility requirements for Medicaid (Medi-Cal in California).
spousal benefits - options offered by some insurance programs to spouses. The options may include allowing spouses who both qualify for the insurance to pay premiums that are less than if each person had purchased individual coverage and/or allowing spouses to use each other's benefits.
standby assistance - when you require the presence of another person, within arms reach of you, to help you perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for standby assistance, rather than or in addition to hands-on assistance.
substantial assistance - hands-on or standby help required to perform activities of daily living.
substantial supervision - continual monitoring of a cognitively impaired person.
tax-qualified - conforming to Federal standards that enable the enrollee in a long term care insurance plan to receive Federal tax advantages.
terminal illness or terminally ill - an illness or injury determined by a physician or other licensed healthcare professional to be likely to result in your death within 6 months.
toileting - an activity of daily living -- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene related tasks.
transferring - an activity of daily living -- the ability to move in or out of a bed, chair or wheelchair.
underwriting - the process of reviewing an individual's health status to determine eligibility for coverage under a long term care insurance plan.
unlimited benefit period - an option under some insurance plans, that pays benefits for as long as you need care, subject to your daily benefit amount or weekly benefit amount. An unlimited benefit period is sometimes called a "lifetime benefit".
waiting period - the time between becoming eligible for benefits and when your long term care insurance actually begins paying those benefits. Sometimes known as an elimination period or a deductible, it helps keep premiums affordable. The longer the waiting period, the lower the premiums. The waiting period can be measured in calendar days or days of service. A days of service waiting period is the number of days you must be eligible for benefits and receiving covered services before your benefits begin.
waiver of premium - a provision of long term care insurance plans that allows you to stop paying premiums while you are receiving benefits.
weekly benefit amount - a way of calculating benefits payable that is more flexible than a daily benefit amount. A weekly benefit amount calculated by multiplying the daily benefit amount you choose times 7. The weekly benefit amount is available with Comprehensive plans only.
